CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital South
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $120
- Cash Discount Price: $174
- vs. Medicare Baseline: 1.26x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital South is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.26x the Medicare baseline. Located in 10010 Kennerly Road, Saint Louis, MO.
Cash / Self-Pay
$174
Average discount available for prompt cash payment at this facility.
Insurance Median
$120
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$95.19
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $95.19 (100%)
Cash / Self-Pay: $174 (183%)
Insurance Median: $120 (126%)
Cash: $174 (183% of Medicare)
Ins. Median: $120 (126% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $11 - $2,270 | 12% |
| Aetna | $15 - $1,048 | 16% |
| Medica Contracted [320239] | $27 - $377 | 28% |
| Ambetter / Centene | $28 - $2,270 | 29% |
| Home State Health Plan Contracted [320187] | $28 - $2,270 | 29% |
| Novasys Contracted [320285] | $28 - $2,270 | 29% |
| Aither Health Contracted [320449] | $44 - $622 | 46% |
| Aither Health [20449] | $44 - $622 | 46% |
| Auxiant Contracted [320462] | $44 - $622 | 46% |
| Ebms Contracted [320493] | $44 - $622 | 46% |
| Edison Health Solutions Contracted [320502] | $44 - $622 | 46% |
| Healthlink Contracted [320179] | $44 - $1,012 | 46% |
| Imagine 360 Contracted [320494] | $44 - $622 | 46% |
| Mercy Benefit Admin Contracted [320251] | $44 - $651 | 46% |
| Mercy Benefit Admin [20251] | $44 - $651 | 46% |
| Reflect Health Contracted [320492] | $44 - $622 | 46% |
| Show-Me Health Administrators Contracted [320483] | $44 - $622 | 46% |
| Yuzu Health Contracted [320521] | $44 - $622 | 46% |
| Cigna | $46 - $1,012 | 48% |
| Blue Cross Blue Shield | $48 - $1,515 | 50% |
| Health Choices Contracted [320448] | $61 - $868 | 64% |
| Health Choices [20448] | $61 - $868 | 64% |
| Medical Associates Health Contracted [320444] | $61 - $868 | 64% |
| American Health Advantage Of Mo Mcr [10473] | $62 | 65% |
| Cherokee Nation Health Serv Contracted [320066] | $62 | 65% |
| Cross Timbers Hospice [20098] | $62 | 65% |
| Dept Of Veteran Affairs Contracted [320106] | $62 | 65% |
| Elara Caring Aspire Hospice Contracted [320433] | $62 | 65% |
| Elara Caring Aspire Hospice [20433] | $62 | 65% |
| Globalhealth Contracted [320145] | $62 | 65% |
| Halo Hcr Inc Hospice Contracted [320432] | $62 | 65% |
| Halo Hcr Inc Hospice [20432] | $62 | 65% |
| Humana | $62 - $1,445 | 65% |
| Kindful Hospice Contracted [320434] | $62 | 65% |
| Kindful Hospice [20434] | $62 | 65% |
| Medicare (plans) | $62 - $1,446 | 65% |
| Mercy Hospice Okc [20252] | $62 | 65% |
| Pace Of The Ozarks Contracted [320518] | $62 | 65% |
| Qual Choice Contracted [320325] | $62 | 65% |
| Tricare | $62 | 65% |
| UnitedHealthcare | $62 - $882 | 65% |
| Federal Medical Center Contracted [320127] | $66 - $940 | 69% |
| Insurance System Inc Contracted [320465] | $66 - $940 | 69% |
| Point C Contracted [320238] | $66 - $940 | 69% |
| Tri State Healthcare Coalition Contracted [320379] | $66 - $940 | 69% |
| Provider Partners Health Plans Contracted [320450] | $68 | 71% |
| St Johns Mercy Rehab Llc Contracted [320359] | $68 | 71% |
| United Medical Resources Contracted [320454] | $68 - $882 | 71% |
| First Health Contracted [320128] | $71 - $1,445 | 75% |
| Mercy Mgd Behavioral Health Contracted [320259] | $71 - $1,012 | 75% |
| Multiplan Contracted [320270] | $71 - $1,084 | 75% |
| Private Health Care Systems Contracted [320320] | $71 - $1,012 | 75% |
| Workers Comp [20426] | $76 - $1,157 | 80% |
| Centivo Contracted [320505] | $104 | 109% |
| Preferred Health Plan Contracted [320522] | $110 | 116% |
| Hope Trust Contracted [320488] | $141 | 148% |